“The Independent” makes a mess on MMR but at least tries to rectify
The Swansea area is in the grip of a massive measles outbreak, with over 800 cases confirmed to date.
To some, perhaps the majority of the population, measles is no more than one of those childhood infectious diseases that everyone used to get, making the victim feel fairly awful for 10 -14 days, a red rash and then full recovery. As a child, I remember having measles aged 11 or 12. I recovered fully, never expecting anything else or being aware that there could be any other outcome. I certainly never knew anyone in school permanently damaged or killed by measles. As usual, Wikipedia provides some excellent articles on measles http://en.wikipedia.org/wiki/Measles
It was only when I went to medical school and starting learning about the potential damage that measles could cause that I looked back and realised that it could have turned out so differently. Measles can lead to complications and long-term damage. Some of the complications can be fatal. A good summary can be found on the NHS Choices website http://www.nhs.uk/Conditions/Measles/Pages/Complications.aspx
One of the greatest developments by medical science has been the development of vaccination as a means of preventing infectious disease. As a result of vaccine development and immunisation programmes, smallpox has been eradicated and polio is close to being eradicated. The first measles vaccine was licensed in the USA in 1963 and in the UK in 1968. The MMR vaccine was developed in the late 1960’s and early 1970’s but it wasn’t until a 1988 trial funded by the Medical Research Council had been carried out that the MMR vaccine became widely available in the UK. For a history of measles vaccination, there’s an excellent article at http://www.mrc.ac.uk/Achievementsimpact/Storiesofimpact/Measles/index.htm
The graph of annual incidence of measles and the impact of vaccination is particularly striking http://www.mrc.ac.uk/consumption/groups/public/documents/content/~export/MRC004005~3~DC_MS_Word~DC_Snippet_Layout/12381-2.jpg
Like any medicine, vaccines can have side-effects and MMR is no different. http://en.wikipedia.org/wiki/MMR_vaccine
The key question is therefore to compare the benefits of any vaccination against the risks. For MMR, while mild side-effects are relatively common, it’s impact on morbidity and mortality has been overwhelmingly positive. Excellent comparisons are available via the NHS Choices website.http://www.nhs.uk/Conditions/vaccinations/Pages/mmr-why-needed.aspx
In 1998, “The Lancet” published an article by Andrew Wakefield and a group based at the Royal Free Hospital in London which made a link between the MMR vaccine, autism and a bowel disorder they entitled “autistic enterocolitis“. Somewhat unusually, Wakefield held a press conference prior to publication where he stated that he couldn’t support the MMR vaccine but suggested that single vaccines should be used. At the time, the issue was largely ignored by the mainstream media. Given that this was a very small study of just 12 children, that was reasonable. It was later work by Wakefield that fuelled the controversy, particularly when there seemed to be a debate about whether the (then) Prime Minister Tony Blair had or had not had his son, Leo, vaccinated with the MMR vaccine. Press interest escalated rapidly and the suggestion that MMR causes autism gained momentum, despite the lack of any real evidence. Misguided and factually incorrect articles were written and published, such as *Warning – Daily Mail articles, but not links to their site* this, this and this. There are many other such articles. Scaremongering, scientifically illiterate and just plain wrong.
MMR vaccination rates fell and took several years to recover as eventually Wakefield’s work was rebutted and disproven. Work conducted by investigative journalist Brian Deer exposed the multiple problems with Wakefield’s research. The Lancet partially, and then fully, retracted Wakefield’s paper. Wakefield was struck off by the General Medical Council in 2010. By this time he was already regarded by the mainstream medical community as persona non grata. A series of articles by Brian Deer was subsequently published in the British Medical Journal, detailing the multiple problems of Wakefield‘s work. Wakefield’s science also seems pretty ropey.
What has all this got to do with “The Independent“? On Saturday, 13th April 2013, in the midst of a massive measles outbreak, it published a front-page article where the headline used a quote from a press release by Wakefield in which he boldly proclaimed “I was right”. Oh dear! This article was also available on its website. The response from the science and medical community was swift and to the point. Martin Robbins wrote a short post on the website of “The New Statesman”, slamming The Independent not just for giving Wakefield the oxygen of publicity but for using that front-page headline. At the time, a conference called “Question, Explore, Discover” was taking place in Manchester – I was at this excellent conference. One of the speakers there was Dr. Rachael Dunlop. Dr. Dunlop is a prominent campaigner against pseudoscience and quackery, with a particular interest in countering misinformation spread by anti-vaccination campaigners, such as the (hopefully soon defunct) Australian Vaccination Network. In her excellent talk, she described how to effectively counter the misinformation spread by groups such as the AVN by, amongst other steps, educating the media against the provision of false balance in science and medicine articles. A great article by Dr. Dunlop on this topic can be found here.
The article in The Independent caused a great deal of consternation in the scientific, medical and skeptical communities. It would have been bad enough for this article to appear at any time, but the timing in relation to the Swansea measles outbreak only served to magnify the wrongness of giving Wakefield a voice to continue to promote his discredited and disproven nonsense about the MMR vaccine. The article may have attempted to provide a more accurate description of how wrong Wakefield is, but it seems it took quite a long time to make those points, having given Wakefield many column inches beforehand and a large article on inside pages based on a press release made by Wakefield. It seems that The Independent had made the classic error of giving false balance in a science/medicine story. Of course, a Twitter shitstorm erupted. As one Tweeter commented “why do the media give a lone, discredited voice in the darkness an equal platform as the whole body of scientific evidence? Is that balance?”. Of course, the answer is no.
On Sunday, 14th April, while on the train home from Manchester, I saw that someone had tweeted a link to the paper’s complaints form. I decided to add my voice to the complaints sent direct to the paper, in addition to a number of Tweets. I didn’t mince my words:-
“You gave a platform for discredited former doctor Andrew Wakefield to air his views on the MMR vaccination. Firstly, you should recall that Wakefield was struck off the GMC Register as a direct result of his fraudulent and unethical research practices which led to the now-retracted publication of his paper in The Lancet. Despite this publication, no-one has ever shown a link between autism and any vaccine, let alone the MMR vaccine. There is no controversy about this except in the mind of Wakefield himself.
Despite this, your newspaper gave him carte blanche to express his views even though he presents no new evidence but merely churns out the same long-discredited and disproven theories. To do this at any time begs a serious question about journalism standards at The Independent. To publish this at a time when there is a massive measles outbreak in the Swansea area is, quite frankly, unconscionable.
Please issue a retraction of this article and remove it from your website. This is not a case of publishing a contradictory report from genuine health/vaccination expert. To do so would merely serve to provide a false balance when the scientific evidence is overwhelmingly in support of the safety and efficacy of the MMR vaccine. If this retraction and removal is not done, I (and I suspect many others) will have no hesitation in reporting this matter to the Press Complaints Commission and to my Member of Parliament.
Publishing this article has to my mind brought your newspaper into disrepute. You have the opportunity to recover at least some respect. I advise you take it.”
Late on the afternoon of Monday, 15th April, I received a reply from Mr. Will Gore, Deputy Managing Editor for The Independent.
“Dear Mr Morgan
Thank you for contacting us via our online complaints form. We are always glad to hear from our readers and I am grateful to you for taking the time to get in touch.
With Swansea in the grip of a measles epidemic, the intervention from Andrew Wakefield – the man behind the original MMR scare – was extraordinary and, we felt, worthy of prominent reporting. We made it absolutely clear from the beginning that Wakefield’s latest claims were noteworthy precisely because they are so wrong and yet he is unrepentant. In the sub-heading to the main article we set out how experts had condemned his ‘outburst’ and in the opening sentence we explained the background to readers by referring to Wakefield as the “discredited doctor who triggered the MMR scare 15 years ago”. In the second paragraph we described how Wakefield was struck off the medical register and noted that there is a “widespread consensus” that it was the panic created by his flawed research which has led to the surge in the disease . We went on to refer to Wakefield as “the chief author of the now infamous and discredited 1998 Lancet paper that first linked the MMR vaccine with bowel disease and autism”. Later in the article we quoted Adam Finn, professor of paediatrics at the University of Bristol, who challenged Wakefield’s recent remarks in stark terms.
In this context, I do not believe readers would be misled into thinking that Andrew Wakefield’s latest, bizarre statement (or his earlier research) carries any scientific weight. It may cause distress to those who have suffered as a result of his past actions – but that is because of its delusional and offensive nature. We carried the statement in full in order to show quite how staggering his defiance remains – in the face of overwhelming evidence against his conclusions and the censure of the medical establishment.
Our leading article went on to dismantle his latest claims one by one, referring in its headline to his “baleful legacy”. It went on to record how: “his research has been discredited; he has lost his job; his reputation is in tatters and his licence to practise medicine has been withdrawn. Efforts to confirm his findings have failed.” We argued that Mr Wakefield “occupies a parallel universe in which his arguments appear internally consistent but which conflict with reality”.
We had no intention of promoting Andrew Wakefield’s discredited hypothesis about the MMR vaccine and I do not believe that our coverage on Saturday will have had that consequence. I have arranged this morning to add an extra link from our online version of his statement to our leading article in order more clearly to signpost readers from one to the other (it appeared in the ‘related articles’ section but I think it appropriate to give it additional prominence, since it effectively rebuts Wakefield’s statement).
Ultimately, I do not agree with your analysis of our coverage but your feedback is very welcome (we published other critical letters in today’s paper). We are among many who very much regret that the lower take up the MMR vaccine some years ago has now resulted in these epidemics. We hold no brief for Mr Wakefield. Rather, as our leading article concluded, we believe simply that “an understanding of why he is wrong will help to ensure he does not do more.”
I hope you won’t hesitate to come back to me if you have further queries or should cause arise in the future.
With kind regards
Deputy Managing Editor
London Evening Standard, The Independent, i & Independent on Sunday”
While I was glad to see that the paper thought it had tried to provide a full rebuttal of Wakefield’s claims, it seemed to me that Mr. Gore had missed the points that a) it should never have published the articles in the first place, b) if it did feel a public interest need to publish the story, it should not have used the headline it did, and c) he hadn’t fully grasped the problem of false balance. I emailed back:-
“Dear Mr. Gore,
Thank you for your prompt response. I appreciate that you may well have been flooded with complaints regarding the front-page article on Wakefield, given the highly inflammatory nature of the subject. I’m grateful that your newspaper has endeavoured to provide the reader with an overview of the issue. However, the real questions here have to be :-
- Why publish an article based on a press release from Wakefield, particularly given facts of how he and his work have been totally discredited and disproven?
- Why publish the article where the headline is basically saying “I was right all along”?
Here lies the crux of the matter:- many people seeing the newspaper in the shops or visiting the website will have seen the front page headline and read no further. It is therefore likely that the headline may have been taken as a statement of truth. Anti-vaccination campaigners will wilfully ignore scientific evidence and are likely to take that headline as a picture or screenshot and post it online, claiming it as evidence that Wakefield really was right, irrespective of the fact that the context will be completely distorted by doing so. This sort of action is typical of groups around the world such as the Australian Vaccination Network (really an anti-vaccination network). The Australian media, however, in recent years, has become well-versed in how to deal with such groups by avoiding the presentation of false balance. I note that you quoted Adam Finn in the article. This gives a perfect example of the false balance issue I’m talking about here, and sadly it is a common failing in the UK media. You have presented two views – Wakefield’s and Finn’s. To many readers these may well come across as simply two diametrically opposing views of equal validity – false balance – when the scientific evidence is so clearly against Wakefield that any attempt at appropriate evidence-based balance would have necessitated publishing interviews with thousands of doctors and scientists.
I, and others, believe that much of our issues with the front-page article could so easily have been avoided by use of a more appropriate headline, pointing out that Wakefield is discredited and disgraced rather than reader having to sift through the article to find out that he is disgraced and discredited – it took several paragraphs before that was mentioned. I’m sure by now you will have read the responses to the article by (amongst others) Tom Chivers, Martin Robbins and Ben Goldacre – if not, you really should. I would also suggest you read the blog post on this subject by Mark Henderson, Head of Communications at the Wellcome Trust :-
Therefore the gist of my complaint remains. If a headline such as Mark Henderson suggested in Point 2 on this blog had been used, the article would be perceived as having a much better tone based on the scientific evidence. Overall, it is far better to handle the likes of attention-seekers such as Wakefield by starving them of the oxygen of publicity. Wakefield is still apparently trying to raise funds to help him continue an ill-conceived defamation action against Brian Deer and the British Medical Journal in a Texan court (although I think the case against the BMJ may have been thrown out). Articles such as this will be used by Wakefield and supporters in fundraising efforts to support such actions which are brought purely in an effort to promote his own discredited work as somehow still having validity when it clearly does not.
I trust you will consider my points made via the complaints forms and in this email further. I await your response.
Dr. Paul Morgan”
On Thursday, 18th April, I received a reply from Mr. Gore:-
“Dear Dr Morgan
Thank you for your further email; I’m sorry for the slight delay in replying.
I absolutely take on board what you say and I can assure you that we have given serious thought to the response our article has generated. As I’m sure you realise, we went into this piece of coverage with the best of intentions and so the criticism from some readers – and others within the scientific/medical community – is not something we take lightly.
In particular, I hear what you say about the headline not being focussed in the right direction – concentrating on what Wakefield said in his statement, rather than on the criticism of his remarks and on him being discredited. With that in mind we decided to change the online headline on Tuesday. I appreciate that such a step does not exactly answer the concerns that have been raised but I think it was the right thing to do.
I am very conscious of the background to the MMR scare and the issues raised by our piece on Saturday have thrown into sharp relief the fact that it is a subject in relation to which we must all remain vigilant.
I do appreciate you taking the trouble to engage with us directly. It is enormously important that readers are able to feed back to us in a meaningful way and I hope you will feel reassured that we are not ignoring the points you and others have made.
With kind regards
Deputy Managing Editor
London Evening Standard, The Independent, i & Independent on Sunday
020 3615 2409″
Thus it seems that the multitude of complaints made to the paper have had a positive impact on the editorial staff. Whether the article’s author, Jeremy Laurance, their Health Correspondent, has taken the criticism on board and learned from it remains to be seen. However, the web version of the original article by Laurance does now appear on the website with a rewritten and far more appropriate headline.
I cannot claim any responsibility for the changed headline – I’m pretty sure my voice was just one amongst many. It would be interesting to know how many complaints The Independent received about these articles. What this does show is that sometimes you can get mainstream media to at least partially rectify the problems inherent in publishing stories with false balance. Not every complaint you make will be acted upon, but it is gratifying to know that sometimes you can help make a difference.
I emailed Mr. Gore back to express my thanks. Hopefully, the paper, its writers and editorial staff, will be more careful in future to not provide the likes of Wakefield with unwarranted publicity and be more careful about providing real balance in stories about science and medicine. It’s role in society is to inform, not mislead – however unintentionally.